Ankylosing spondylitis

Abstract

Ankylosing spondylitis occurs chiefly in young men and affects principally the sacroiliac, apophyseal, and costovertebral joints. Physical findings may be minimal, and special tests may be necessary to find objective evidence of the disease. HLA-B27 histocompatibility antigen is present in 90% to 95% of patients. The feature of highest diagnostic significance is the roentgenographic finding of syndesmophytes. The natural course of the disease is characterized by spontaneous remissions and exacerbations and by possible arrest at any stage. In general, the prognosis is good for maintenance of functional ability despite the development of severe back deformities. In management, emphasis must be given to maintaining normal posture and body habitus and to encouraging the patient to cope with individual needs and problems. If basic measures, including salicylate therapy, do not control the disease, additional drug therapy must be initiated. Surgical intervention is a last resort.